Treatment of refractory status epilepticus with propofol: Clinical and pharmacokinetic findings

Mark M. Stecker, Thomas H. Kramer, Eric C. Raps, Rosemary O'Meeghan, Eugene Dulaney, Debra J. Skaar

Research output: Contribution to journalArticle

197 Scopus citations


Purpose: We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels. Methods: Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol. Results: Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) than with high-dose barbiturate therapy (82%). The time from initiation of high-dose barbiturate therapy to attainment of control of RSE was longer (123 min) than the time to attainment of seizure control in the group receiving propofol (2.6 min, p = 0.002). Plasma concentrations of propofol associated with control of SE were 14 μM ± 4 (2.5 μg/ml). Recurrent seizures were common when propofol infusions were suddenly discontinued but not when the infusions were gradually tapered. Conclusions: If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.

Original languageEnglish (US)
Pages (from-to)18-26
Number of pages9
Issue number1
StatePublished - Mar 26 1998


  • Barbiturates
  • Propofol
  • Seizures
  • Status epilepticus
  • Treatment

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